How much money is waiting to be retrieved from your insurance claims?

I love following up on insurance claims while being on hold and getting the run-around from the insurance representatives, said no one! This particular task is very time-consuming and it is for this reason, so many practices have a long list of claims sitting around getting too old to retrieve. Most insurance companies give you up to 1 year from the original date of service, to submit a claim. It is important to realize that, just because the claim was submitted on your end, it doesn’t mean the insurance truly received it (this includes electronic claims too.) Let’s learn how to ensure you don’t currently or will end up with, thousands of dollars in dental claims that could potentially be lost for ever.

One of the first items I learn about, when helping a practice is the status of outstanding claims. Unfortunately, this important follow-up item tends to be overlooked quite often. In one particular office, I was able to improve the collection rate by $100k from the previous year after 3 months, by mainly focusing on claims follow-up. It was not easy and as I mentioned, it was very time-consuming. In this case, the issue was: lack of training and lack of admin time which allowed a staff member to dedicate hours on the phone with the insurance companies. Other reasons for the issue are staff-turnover, lack of staff, giving up on claims too easily or not submitting the required information along with the claims.

I’m going to ask you to run an outstanding claims report from your software, real quick, no need to print it out. How many claims do you see that are over 90 days old or older? Pick one of those and take a look at the notes about that date of service (every software has a different designated area for this.) If you find notes about that date of service, in which your staff has been communicating with insurance regarding the status, you’re on a good path but not necessarily in the clear.

One of the most frequent denials every office deals with is SRP’s. For some reason the insurance can dictate the standard of care for your patients. That’s absurd and we can rant about this some other time. Anyway, I bring this up because most staff, give up and don’t dispute the claim because of the reason given by the insurance, that it was not medically necessary or something to that effect. I’m telling you, it can be disputed and paid. (I get this paid all the time!) Other procedures get denied similarly and can also be paid. If you find yourself writing off balances or billing the patient for something that should have been paid, you’re staff is giving up to easily and you might be getting some upset patients. All bad

Regularly running a report, following up with insurance, properly documenting the reasons, and tracking the status will help you avoid the issues mentioned. But, before you go and push your staff with unrealistic outcomes and expectations, talk to them. Once in a while they could use an extra hand to tackle this task. One doctor I was employed for some years back, understood that we were short staffed and personally helped call on a few claims here and there. (It was so funny when he started yelling at them and saying “we already sent you all of that info, what is wrong with you?” He felt my pain…lol) I am definitely NOT recommending you help with claims, please don’t do that! What I am trying to say is that sometimes, your practice may need help with this task and it’s not necessarily your staff’s fault that it has fallen behind (to a degree.) Reach out for temporary help when you need it, outsource it, hire more staff, just don’t let it go.

For training or assistance with claims retrieval contact us.

Leave a Reply

Your email address will not be published. Required fields are marked *